ED Management : the Monthly Update on Emergency Department Management

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To boost performance on a range of metrics, the 55-bed ED at NYU Lutheran Medical Center in Brooklyn, NY, transitioned to a pod system in August 2016. The approach, which is designed to foster team-based care, involves assigning physicians and nurses to designated geographic areas throughout the day, minimizing the movement of physicians as well as the need for phone communication. When coupled with other changes, including the introduction of point-of- care testing, the pod initiative has enabled the ED to reduce lengths of stay for all treat-and-release patients to less than three hours for the first time in the history of the department, according to administrators...

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A new clinical index tool designed specifically for the emergency environment predicts the risk for future firearms violence in young people 14-24 years of age. The approach employs a brief, 10-point instrument that can be administered in one to two minutes, according to investigators. They also note that while the tool is based on data from a single ED in Flint, Ml, the tool should be applicable to urban EDs in regions that have similar characteristics. To create the tool, investigators used data from the Flint Youth Injury Study, an investigation of a group of patients 14-24 years of age who reported using drugs in the previous six months and accessed care at a Level I trauma center...

As the benefits of palliative care become more evident in clinical trials, there is growing interest in making such resources available to patients at an earlier stage, such as the ED. However, experts note that emergency staff first must identify available resources and make sure that providers have the primary palliative care skills needed to effectively introduce the topic to appropriate patients and families. Research shows that initiating the call for a palliative care consult while the patient is in the ED can deliver quality-of-life benefits even three months later...

A new study suggests older patients are particularly vulnerable to functional decline in the six months following a visit to the ED. Investigators noted the findings suggest there are opportunities to short-circuit this trajectory with added assessment and arrangements for follow-up interventions at the time of the ED visit. . Investigators compared 754 older patients who visited the ED with a matched group of 813 patients who did not visit an ED. They also studied an unmatched group of older patients who were hospitalized following an ED visit...

The ED at the University of Colorado Hospital (UCH) has undergone a dramatic transformation in recent years, doubling in size while also using process improvement methods to dramatically reduce wait times, eliminate ambulance diversion, and boost patient satisfaction. Throughout this period, volume has continued to increase while the cost per patient and avoidable hospital admissions have experienced steady declines. Guiding the effort has been a series of core principles, with a particular focus on making sure that all processes are patient-centered...

With high-profile travel bans and well-publicized Immigration and Customs Enforcement (ICE) activities, frontline providers have noticed changes in the behavior of immigrant patients. Some emergency providers report there is more fear and a reluctance to share key information. Also, providers are concerned that worries about deportation will cause immigrant patients to refrain from accessing needed care. Investigators note that such concerns are valid, considering how heightened ICE activities previously have affected immigrant health...

With President Trump and congressional Republicans promising to repeal or replace parts of the entirety of the Affordable Care Act (ACA), emergency medicine stakeholders are making sure lawmakers know what provisions in the law must remain intact, and what new reforms are needed. They also are urging emergency medicine clinicians to stay informed on the issues, and to advocate for their interests. The American College of Emergency Physicians (ACEP) wants to ensure that emergency services remain essential covered benefits, and that freestanding EDs and other emerging healthcare delivery models are supported...

Investigators have applied epidemiological principles to the study of workplace violence, producing results that offer intriguing information to hospitals struggling for a way forward on this issue. In a randomized, to hospitals struggling for a wary forward on this issue. In a randomized, controlled trial, the researchers found that a one-time, unit-based intervention can reduce the incidence of violent events, and that the approach offers some lasting effect over time. The intervention consisted of a 45-minute discussion with unit supervisors in which unit-specific data regarding violent incidents in their workplace were shared along with an array of improvement strategies...

With influenza season intensifying, many EDs report strong surges in flu related volume. Although illness severity does not appear to be atypical, hospitals that see high numbers of older patients and the chronically ill face extra challenges meeting the needs of patients who have added susceptibility to flu-related complications. Experts note that all flu strains circulating this year appear to be sensitive to antiviral medications. In mid-February, the CDC reported the number of flu cases was still on the increase in most regions of the country, with 28 states reporting a high incidence of influenza-like illness...

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Although there is solid evidence to support how patients presenting with migraine headaches should be treated in the ED, studies show there is wide variation in the care that these patients receive. To reduce this variation, experts have unveiled guidelines based on a review of 68 randomized, controlled trials that looked at 28 injectable migraine medications. Investigators did not present any A-level, or "must offer," recommendations, but four medications received B-level, or "should offer," recommendations...

With data showing continued increases in the use of antibiotics, even in cases in which such prescribing is unnecessary and ill-advised, both the CDC and TJC are pushing initiatives aimed at improving antibiotic stewardship. The initiatives stress the importance of patient and provider education, the tracking of antibiotic use and resistance, and the need for top-level support. Although smaller hospitals face challenges in meeting the new standards, some health systems are getting around the problem through the use of telemedicine...

Although much of the research on sepsis has focused on early recognition and treatment, the CDC issued a new report highlighting opportunities to prevent the condition from developing. To facilitate improvements in this area, investigators highlighted data showing which infections and healthcare factors are associated most commonly with sepsis so that providers can improve their efforts. Investigators reviewed the medical records of 246 adult patients diagnosed with severe sepsis or septic shock at four New York hospitals, finding that the most common types of infections associated with sepsis were respiratory tract, urinary tract, gastrointestinal, and skin and soft tissue...

Working with an entrepreneurial startup company, Aurora Health Care in Milwaukee has developed an approach for leveraging the services of one provider who sees patients remotely during the triage process at multiple ED sites. The process has enabled the health system to accelerate throughput times while maximizing provider resources and boosting patient satisfaction. At Aurora Sinai Medical Center in Milwaukee, the approach has reduced door-to-provider times from 60 minutes to about 10 minutes, on average. In addition, the average length of stay has declined by 40 minutes, and the leave-without-being-seen rate has plummeted from 8% to 2%...

A growing number of hospitals are turning to predictive analytics to anticipate and manage volume better. The approach, which involves using sophisticated simulation and modeling techniques, enables administrators to get ahead of patient surges and to focus on pressure points. For example, Johns Hopkins Hospital in Baltimore has made significant progress on a range of measures, using a centralized command center to monitor the hospital's data streams. The approach enables the hospital to accelerate decision-making and optimize hospital resources...

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A number of communities are turning to community paramedicine programs to help manage the crushing demand on EDs and EMS providers by patients with behavioral health (BH) concerns. In Modesto, CA, a pilot program provides extra training to paramedics to respond to BH-related calls, and a program in Atlanta pairs paramedics with mental health social workers to meet the needs of BH patients, many of whom repeatedly call 911 for help. Both programs curb the need for hospital and ED visits while linking patients with appropriate care more expeditiously...

Some community hospitals that struggle to maintain a financially viable pediatric inpatient service have found success with a model that combines their pediatric inpatient unit with a pediatric ED. The approach was developed first at Howard County General Hospital in Columbia, MD, nearly two decades ago, and has been duplicated at other community hospitals in the state. Now, community hospitals elsewhere are taking a look. In addition to the financial benefits, users of this approach say that it can improve throughput while also boosting patient and provider satisfaction...